who seeks treatment— unmarried men with inherited money.”8 But Abraham’s six Poliklinik staff were soon swamped with patients from all social backgrounds: they performed twenty analytic sessions on opening day. Though it was supposedly free, most patients did in fact make a modest contribution, evaluated on a sliding scale according to their means. Factory workers, office clerks, academics, artisans, domestic servants, a bandleader, an architect, and a general’s daughter were expected to pay, Eitingon explained, only “as much or as little as they can or think they can for treatment.” Freud praised Eitingon for initiating the drive to make psychoanalysis accessible to “the great multitude who are too poor themselves to repay an analyst for his laborious work.”9
The Berlin Poliklinik was always intended to be a flagship institution, and following its rapid success— 350 people applied for treatment in its first year— a second free clinic was founded two years later in Freud’s native city (between the wars at least a dozen more were opened in seven countries and ten cities, from Paris to Moscow). According to Ernest Jones, who set up a clinic in West London in 1926, Freud was initially “lukewarm” about the idea of having a free clinic in Vienna, because he felt that only he could head it. However, the Berlin Poliklinik seemed to have turned its city into the new capital of psychoanalysis— Fenichel emigrated there in 1922, attracted by its vibrant reputation— and the Viennese analysts didn’t want to be upstaged. Paul Federn (then Reich’s analyst), Helene and Felix Deutsch, and Eduard Hitschmann pressed the idea upon Freud.
In May 1922 Hitschmann, a specialist in female frigidity (Reich had given Hitschmann’s book on the subject to Lia Laszky), was appointed the first director of Vienna’s Ambulatorium. Helene Deutsch later described Hitschmann, a resolute Social Democrat who had been practicing analysis since 1905, as “a cultured, witty man . . . 200 percent ‘normal.’ ”10 Reich became Hitschmann’s first clinical assistant and would remain at the Ambulatorium for the rest of the decade. In 1924, he became the clinic’s deputy medical director with the job of interviewing and examining all prospective patients, sending off the ones he suspected of having a physical rather than a psychosomatic illness for X-rays and blood tests, and assigning the rest to an analyst. Each member of the Vienna Psychoanalytic Society promised to treat at least one patient for free to support the clinic, which represented a fifth of their practice. If they couldn’t spare the time, Reich would collect the equivalent in monthly dues.
The Ambulatorium had been two years in the planning not only because of Freud’s initial intransigence but because the psychiatrist Julius Wagner-Jauregg, a member of the conservative Christian Social Party and the head of the Society of Physicians, had blocked the proposals to launch a free clinic connected to the Garrisons-Spital (military hospital). Wagner-Jauregg, the director of the University Clinic for Psychiatry and Nervous Diseases, was then Vienna’s most celebrated doctor and one of Freud’s most notorious and sarcastic critics— “His whole personality,” his onetime assistant Helene Deutsch wrote in describing his resistance to psychoanalysis, “was too deeply committed to the rational, conscious aspects of life.”11 With the support of other psychiatrists who were not well-disposed toward psychoanalysis, Wagner-Jauregg, who took an entire year to examine Hitschmann’s proposal for the free clinic before he rejected it, argued that the clinic was an unnecessary supplement to existing ones like his own and constituted a breach of trade.
Reich would no doubt have been aware of Wagner-Jauregg’s efforts to block the Ambulatorium when he began a two-year stint of postgraduate work in neuropsychiatry with Wagner-Jauregg and Paul Schilder, the doctor to whom Reich had referred Lore Kahn’s mother. When Reich studied under him, Wagner-Jauregg was experimenting with electrotherapy and insulin shock treatments, and with inducing malaria to cure the dementia associated with the final stages of syphilis. It was found that the resulting fever could kill all pathogenic bacteria; the innovation would win him the Nobel Prize in 1927.
Wagner-Jauregg had been a friend of Freud’s when they were students. He once carried him to bed after Freud blacked out from drink, and he was one of the few to use the familiar du to address him. However, the pair fell out in 1920 when Freud testified against Wagner-Jauregg before a parliamentary commission. Wagner-Jauregg had been accused of excessive use of force in treating the military “malingerers,” as he called those he felt were feigning illness as a form of desertion. At the beginning of the war he had treated war neurotics with isolation and a milk diet, but he soon found that a strong dose of electric shock therapy was the best method of getting “simulators” to return to active duty, a feat he claimed to have achieved after as little as one session of torture. Freud accused him of having used psychiatry like a machine gun to force sick soldiers back to the front. In his autobiography, Wagner-Jauregg wrote that he considered Freud’s public statement a “personal attack.”12
Reich received his first exposure to schizophrenic patients when he worked as an intern for a year on the “chronic ward” at the Steinhof State Lunatic Asylum in Vienna. There Wagner-Jauregg used bromides and barbiturates to sedate patients, which, Reich noticed critically, had no effect on their underlying psychotic symptoms. He wrote sympathetically of the inmates, “Each and every one of them experienced the inner collapse of his world and, in order to keep afloat, had constructed a new delusional world in which he could exist.”13 His own analyst, Paul Federn, claimed some success in penetrating and curing schizophrenic fantasies using psychoanalysis. Reich liked Wagner-Jauregg’s “rough peasant candour” and admired his impressive diagnostic skill, but working with him created split loyalties.14 Reich had already decided to give over his career to psychoanalysis, but to avoid being a target of his professor’s derisive wit, at Wagner-Jauregg’s clinic he made sure to exclude all mention of sexual symbolism from his patients’ case histories.
The Ambulatorium, which eventually opened at the General Hospital (where Felix Deutsch was a physician) just after Freud turned sixty-six, couldn’t have been more different from its sleek, modernist cousin in Berlin. Its shabby clapboard building was a carbuncle on the Beaux Arts architecture that surrounded it. The building was shared with the Society of Heart Specialists, whose physicians vacated it in the afternoons. The psychoanalysts used the emergency entrance for heart-attack victims as a meeting room, and the unit’s four ambulance garages made makeshift consulting rooms. A metal examination table with an uncomfortable springboard mattress doubled as a couch (patients had to use a stepladder to get onto it), and the analyst perched on a hard wooden stool. “After five sessions we felt the effects of so long a contact with the hard surface,” recalled the psychoanalyst Richard Sterba.15 He had occupied both the stool and the table, having been analyzed at the Ambulatorium for free by Hitschmann and later, with Reich’s help, having gotten his first job at the clinic.
There was nothing elitist about psychoanalysis as Reich practiced it at the Ambulatorium. According to a report published by Hitschmann in 1932, 22 percent of the clinic’s patients were either housewives or unemployed, and another 20 percent were laborers. In its first decade, 1,445 men and 800 women were treated in the Ambulatorium’s improvised space, more than the 1,955 people treated at the Berlin Poliklinik. “The consultation hours were jammed,” Reich recalled, “There were industrial workers, office clerks, students, and farmers from the country. The influx was so great that we were at a loss to deal with it.”16
These figures are especially impressive, considering the skeleton staff with which the institution operated, and show how accepted psychoanalysis was increasingly becoming among the general public. But they also show how far psychoanalysis was from providing what Eitingon ambitiously called “therapy for the masses.”17 Eitingon himself regretted that the clinics couldn’t reach more “authentic proletarian elements.” Yet it was specifically the ambition